Method for performing minimally invasive surgury

ABSTRACT

Pedicle screw apparatuses each including a pedicle screw assembly and an attached pedicle screw extender are placed in a true percutaneous manner, thereby overcoming issues resulting from placing pedicle screw assemblies through a retractor. Thus, a retractor can advantageously be built off of the pedicle screw apparatuses, thereby allowing visualization of the spine anatomy directly. Furthermore, such a method for performing surgery ensures ideal placement of the retractor for additional procedures that are often required such as, for example, decompression, interbody device placement, etc.

FIELD OF THE DISCLOSURE

The disclosures made herein relate generally to components, systems andapparatuses used for orthopedic and other types of invasive surgery and,more particularly, to components, systems and apparatuses used inperforming minimally invasive spinal surgery.

BACKGROUND

A minimally invasive surgical procedure is a surgical procedure that isless invasive than open surgery used for the same type of procedure.Minimally invasive surgery is typically performed through several smallincisions (e.g., slits, punctures or the like) as opposed to one or morelarge incisions as is used in open surgery. In a typical minimallyinvasive spinal surgery, an endoscope and/or surgical instruments arepassed through these incisions. The endoscope, which includes a thin,lighted tube with an attached camera, enables a surgeon to view an areabeing operated on using a monitor. Alternatively to using an endoscopeor in conjunction with use of an endoscope, an operating microscope canbe used. By performing the surgical procedure through small incisions,the surgeon can safely work on the site being operated on whiledisturbing only a minimal portion of surrounding tissue, organs, etc. Asa result, patients are less likely to develop complications, they aremore likely to recover more quickly, and can typically return to normalactivities sooner in comparison to open surgery.

In performing minimally invasive surgical procedures of the spine (i.e.,minimally invasive spine surgery), use of a retractor is often desirableor necessary. One current approach for minimally invasive spine surgeryis to first install a retractor and then, through use of sequentiallydilating tubes or other means, installing pedicle screws, fixation rodsand/or the like through a passage defined by tissue retracted by theretractor. This approach has the drawback of less than accurateplacement of the pedicle screw due to the distal end of the tubes notbeing precisely placeable and/or the retractor causing inadequatevisualization of the pedicle screws when using fluoroscopy.

Therefore, an approach configured for first percutaneously placing thepedicle screws and then building a retractor off of the pedicle screwswould overcome drawbacks associated with prior art approaches forplacing pedicle screws in minimally invasive spine surgery, thus makingsuch approach advantageous, desirable and useful.

SUMMARY OF THE DISCLOSURE

Embodiments of the present invention include pedicle screw systems andmethod of use configured for being used in surgical procedures such as,for example, minimally invasive retractor system designed for lumbarspine fusion surgery, lumbar diskectomy surgery and the like. Suchembodiments overcome adverse issues associated with prior art approachesof placing pedicle screw assemblies through a retractor. Such prior artapproaches result in inadequate visualization of the pedicle usingfluoroscopy through the retractor. It is disclosed herein thatembodiments of the present invention are well suited for various typesof spine-related surgical procedures and applications, but can also beused in other types of surgical procedures and applications.Accordingly, embodiments of the present invention are not unnecessarilylimited to use in any particular type of surgical procedure orapplication.

In accordance with embodiments of the present invention, pedicle screwassemblies and pedicle screw extenders detachably attached to thepedicle screw assemblies are placed in a true percutaneous manner,thereby overcoming issues resulting from placing pedicle screwassemblies through a retractor. Accordingly, embodiments of the presentinvention advantageously allow retractor placement over a pedicle screwassembly/pedicle screw extender construct allows visualization of thespine anatomy directly. Furthermore, in accordance with embodiments ofthe present invention, building the retractor off the pedicle screwassemblies and attached pedicle screw extenders ensures ideal placementof the retractor for additional procedures that are often required(e.g., decompression, interbody device placement, etc).

In one embodiment of the present invention, a method for performingsurgery can comprise a plurality of the following operations. Anoperation can be performed for providing a pedicle screw apparatusincluding a pedicle screw assembly having a first end portion of apedicle screw extender attached thereto in a manner providing forsimultaneous transfer of rotational torque applied thereto to a screwportion of the pedicle screw assembly and for maintaining a longitudinalaxis of a fixation rod receiving body of the pedicle screw assembly insubstantially coincidental alignment with a longitudinal axis of thescrew portion. An operation can be performed for anchoring the pediclescrew assembly to a bony structure of a patient. Such anchoring includesusing the pedicle screw extender to apply rotational torque to the screwportion of the pedicle screw assembly. An operation can be performed forengaging a blade body with the pedicle screw extender in a mannerallowing the blade body to be moved along the pedicle screw extenderfrom a second end portion thereof toward the first end portion thereofafter the pedicle screw assembly is anchored within the bony structureand while the pedicle screw extender is engaged with the pedicle screwassembly. An operation can be performed for moving the blade body fromadjacent the second end portion of the pedicle screw extender toward thefirst end portion thereof for positioning a first end portion of theblade body within tissue of the patient. An operation can be performedfor engaging a retractor attachment structure at the second end portionof the blade body with a blade body mounting structure of a retractorafter performing such moving.

In another embodiment of the present invention, a method for performingminimally invasive surgery can comprise a plurality of the followingoperations. An operation can be preformed for engaging a first endportion of a pedicle screw extender with a fixation rod receiving bodyof a pedicle screw assembly. The pedicle screw extender is engaged in amanner allowing simultaneous transfer of rotational torque appliedthereto to a screw portion of the pedicle screw assembly and maintaininga longitudinal axis of the fixation rod receiving body in substantiallycoincidental alignment with a longitudinal axis of the screw portion. Anoperation can be performed for anchoring the pedicle screw assembly to abony structure of a patient through a minimally invasive access openingin tissue at a surgery site. Such anchoring includes using the pediclescrew extender to apply rotational torque to the screw portion of thepedicle screw assembly. An operation can be performed for engaging ablade body with the pedicle screw extender at an exposed position abovethe tissue after the pedicle screw assembly is anchored within the bonystructure and while the pedicle screw extender is engaged with thepedicle screw assembly. An operation can be performed for sliding theblade body from a second end portion of the pedicle screw extendertoward the first end portion of the pedicle screw extender forpositioning a first end portion of the blade body within the minimallyinvasive access opening in the tissue. An operation can be performed fordisengaging the pedicle screw extender from the pedicle screw assembly.An operation can be performed for withdrawing the pedicle screw extenderfrom within the minimally invasive access opening in said tissue afterdisengaging the pedicle screw assembly therefrom. Such withdrawing caninclude disengaging the pedicle screw extender from the blade body whilethe first end portion of the blade body remains within the minimallyinvasive access opening. An operation can be performed for engaging aretractor attachment structure at the second end portion of the bladebody with a blade body mounting structure of a retractor afterperforming such withdrawing.

In another embodiment of the present invention, a method for performingsurgery can comprise a plurality of the following operations. Anoperation can be performed for anchoring a first pedicle screw apparatusto a first bony structure of a patient and a second pedicle screwapparatus to a second bony structure of the patient. Each one of thepedicle screw assemblies includes a pedicle screw assembly having afirst end portion of a pedicle screw extender attached thereto in amanner providing for simultaneous transfer of rotational torque appliedthereto to a screw portion of the pedicle screw assembly and formaintaining a longitudinal axis of a fixation rod receiving body of thepedicle screw assembly in substantially coincidental alignment with alongitudinal axis of the screw portion. An operation can be performedfor engaging a first blade body with the pedicle screw extender of thefirst pedicle screw assembly and a second blade body with the pediclescrew extender of the second pedicle screw assembly after performingsuch anchoring and while each one of the pedicle screw extends isengaged with the respective one of the pedicle screw assemblies. Anoperation can be performed for displacing each one of the blade bodiesfrom a second end portion of the respective pedicle screw extendertoward the first end portion thereof for positioning a first end portionof each one of the blade bodies within tissue of the patient adjacentthe respective one of the bony structures. An operation can be performedfor disengaging each one of the pedicle screw extenders from therespective one of the pedicle screw assemblies. An operation can beperformed for engaging a retractor with both of the blade bodies afterperforming such displacing.

These and other objects, embodiments, advantages and/or distinctions ofthe present invention will become readily apparent upon further reviewof the following specification, associated drawings and appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view showing a retractor apparatus configured inaccordance with the present invention, wherein blade bodies thereof arein an adjacent orientation.

FIG. 2 is a perspective view of the retractor apparatus shown in FIG. 1,wherein the blade bodies are in a retracted orientation.

FIG. 3 is a top of the retractor apparatus shown in FIG. 1, wherein theblade bodies are in a retracted orientation.

FIG. 4 is a side view of the retractor apparatus shown in FIG. 1,wherein the blade bodies are in a retracted orientation.

FIG. 5 is a perspective view of a blade body assembly configured inaccordance with the present invention, wherein a blade body of the bladebody assembly is in a seated position with respect to a blade bodysurround of the blade body assembly.

FIG. 6 is a perspective view of the blade body assembly shown in FIG. 5,wherein the blade body surround is in a displaced position with respectto the blade body.

FIG. 7 is a perspective view of the blade body assembly shown, in FIG.5, wherein a separation tool is attached to the blade body surround.

FIG. 8 is a perspective view showing a pedicle screw extender assemblyconfigured in accordance with the present invention.

FIG. 9 is a perspective view of the pedicle screw extender assemblyshown in FIG. 8, wherein a separation tool is engaged with a blade bodysurround of the pedicle screw extender assembly.

FIG. 10 is a perspective view of the pedicle screw extender assemblyshown in FIG. 8, wherein the blade body surround is in a displacedposition with respect to the blade body.

FIG. 11 is a cross-sectional view of a blade body retainer of thepedicle screw extender assembly shown in FIGS. 8-10.

FIG. 12 is a partial fragmentary cross-sectional view showing a pediclescrew extender configured in accordance with the present inventionengaged with a pedicle screw assembly, wherein an extension portion ofthe pedicle screw extender is engaged with a fixation rod receiving bodyof the pedicle screw assembly and a torque application member of thepedicle screw extender is disengaged from a bone screw of the pediclescrew assembly.

FIG. 13 is a partial fragmentary cross-sectional view of the pediclescrew extender shown in FIG. 12, wherein the extension portion of thepedicle screw extender is engaged with the fixation rod receiving bodyof the pedicle screw assembly and the torque application member of thepedicle screw extender is engaged from the bone screw of the pediclescrew assembly.

FIG. 14 is a perspective view showing a tissue dilator configured inaccordance with the present invention, wherein the tissue dilator isengaged with a blade body assembly configured in accordance with thepresent invention.

DETAILED DESCRIPTION OF THE DRAWING FIGURES

Referring to FIGS. 1-4, a retractor apparatus 100 configured inaccordance with a first embodiment of the present invention is shown.The retractor apparatus 100 finds use in surgical procedures such as,for example, lumbar spine fusion surgery, lumbar diskectomy surgery andthe like. The retractor apparatus 100 overcomes adverse issuesassociated with prior art approaches of placing pedicle screw assembliesthrough a retractor such as, for example, inadequate visualization ofthe pedicle using fluoroscopy through the retractor. The retractorapparatus 100 and associated surgical retractor component system areconfigured for allowing pedicle screw assemblies to be placed in a truepercutaneous manner, thereby overcoming issues resulting from placingpedicle screw assemblies through a retractor.

The retractor apparatus 100 includes a retractor 101, a first blade body102, a second blade body 104, a third blade body 106 and a fourth bladebody 108. The retractor 101 includes a frame structure 110, a firstblade translating unit 112, a second blade translating unit 114, and athird blade translating unit 116. A stationary blade mounting structure118 of the frame structure 110 has a first blade translation unitmounting structure 120 and a second blade translation unit mountingstructure 122 attached thereto. The first and second blade translationunit mounting structures 120, 122 extend in opposing directions from thestationary blade mounting structure 118 along a first reference axis A1.The first blade translating unit 112 is mounted on the first bladetranslation unit mounting structure 120 in a manner allowing the firstblade translating unit 112 to be selectively translated along a lengthof the first blade translation unit mounting structure 120. Similarly,the second blade translating unit 114 is mounted on the second bladetranslation unit mounting structure 122 in a manner allowing the secondblade translating unit 114 to be selectively translated along a lengthof the second blade translation unit mounting structure 122. Thus, adistance between the first and second blade bodies 102, 104 can beselectively varied.

A third blade translation unit mounting structure 124 is attached to thestationary blade mounting structure 118 through an extension member 126.The extension member 126 is configured for spacing the third bladetranslation unit mounting structure 124 away from (i.e., offsettingfrom) the stationary blade mounting structure 118. The third bladetranslation unit mounting structure 124 extends from the extensionmember 126 in a manner whereby it extends along a second reference axisA2. The second reference axis A2 extends substantially perpendicular tothe first reference axis A1. The third blade translating unit 116 ismounted on the third blade translation unit mounting structure 124 in amanner allowing the third blade translating unit 116 to be selectivelytranslated along a length of the third blade translation unit mountingstructure 124, thereby allowing a distance between the third and fourthblade bodies 106, 108 to be varied. In this manner, the bladetranslation units mounting structure 112, 114 and 116 allow opposingones of the blade bodies (102, 104, 106, 108) to be moved between anadjacent orientation BBO1 with resect to each other (FIG. 1) and aretracted orientation BBO2 with resect to each other (FIGS. 2-4).

It is disclosed herein that, in one embodiment, a blade translating unitbeing mounted on a blade translation unit mounting structure in a mannerallowing the blade translating unit to be selectively translated along alength of the blade translation unit mounting structure includes theblade translation unit mounting structure having a surface feature(e.g., teeth) that are engaged by a mating structure (e.g., cog withteeth) of the blade translating unit. Preferably, a blade translatingunit in accordance with the present invention includes a means forselectively inhibiting movement of the blade translating unit in atleast one direction of travel thereof. For example, each one of theblade translating units (112, 114, 116) can include a movement causingdevice 128 and a movement inhibiting device 130. Rotation of themovement causing device 128 causes the respective one of the bladetranslating units (112, 114, 116) to move along the respective bladetranslation unit mounting structure in a first direction (e.g., awayfrom the stationary blade mounting structure 118) and movement in thesecond direction is inhibited until the movement inhibiting device 130of the same one of the blade translating units (112, 114, 116) isdeactivated (i.e., manually depressed). In this manner, movement of eachone of the blade translating units (112, 114, 116) along a length of therespective one of the blade translation unit mounting structures (120,122, 124) in either direction can be selectively controlled.

Each one of the blade translating units (112, 114, 116) includes arespective blade body mounting structure (132, 134, 136) attachedthereto. The blade body mounting structure 132 of the first bladetranslating unit 112 has the first blade body 102 mounted thereon. Theblade body mounting structure 134 of the second blade translating unit114 has the second blade body 104 mounted thereon. The blade bodymounting structure 136 of the third blade translating unit 112 has thethird blade body 106 mounted thereon. The stationary blade mountingstructure 118 includes a blade body mounting structure 138 having thefourth blade body 108 detachably mounted within grooves 140 thereof. Thefirst and second blade bodies 102, 104 are sometimes referred to asprimary blade bodies. The third and fourth blade bodies 106, 108 aresometimes referred to as secondary blade bodies. The blade body mountingstructures (132, 134, 136, 138) to which the blade bodies 102, 104, 106,108) are attached are sometimes referred to by similar nomenclature(e.g., primary blade body mounting structure and secondary blade bodymounting structure). The primary and the secondary blade bodies can beof different configuration (e.g., the primary blade bodies configuredfor angulation and secondary blade bodies not being configured forangulation).

As shown in FIGS. 1-4, a retractor attachment structure 142 of each oneof the blade bodies (102, 104, 106, 108) is provided at a first endportion 143 of each one of the blade bodies (102, 104, 106, 108). Theretractor attachment structure 142 of each one of the blade bodies (102,104, 106, 108) is mounted on (i.e., engaged with) a respective one ofthe blade body mounting structures (132, 134, 136, 138) in a mannerallowing angulation (i.e., rotation) thereabout and, optionally,translation therealong. Each retractor attachment structure 142 has amounting structure receiving passage 145 extending therethrough and theengaged one of the blade body mounting structures (132, 134, 136, 138)is engaged within the mounting structure receiving passage 145 of arespective one of the blade bodies (102, 104, 106, 108), therebyallowing angulation and, optionally, translation of the respective oneof the blade bodies (102, 104, 106, 108) relative to the engaged one ofthe blade body mounting structures (132, 134, 136, 138). It is disclosedherein, however, that one or more of the blade bodies (102, 104, 106,108) can be engaged with the respective one of the blade body mountingstructures (132, 134, 136, 138) in a manner that substantially inhibitsangulation and/or translation of the respective one of the blade bodies(102, 104, 106, 108) relative to the engaged one of the blade bodymounting structures (132, 134, 136, 138).

Each one of the blade bodies (102, 104, 106, 108) includes a respectiveblade securing device 144 engaged within a blade securing device passage147. The blade securing device 144 of each one of the blade bodies (102,104, 106, 108) is used for securing the respective one of the bladebodies (102, 104, 106, 108) in a fixed orientation (i.e., angulated andtranslated orientation) with respect to the engaged one of the bladebody mounting structures (132, 134, 136, 138). In one embodiment(shown), the blade securing device 144 of each one of the blade bodies(102, 104, 106, 108) is a setscrew, pin, or other suitable type offastener or device. The blade securing device 144 is selectively movablebetween a first position (e.g., untightened) for allowing the respectiveone of the blade bodies (102, 104, 106, 108) to be pivoted about andtranslated along the engaged one of the blade body mounting structures(132, 134, 136, 138) and a second position (e.g., tightened) forsubstantially inhibiting movement of the respective one of the bladebodies (102, 104, 106, 108) with the engaged one of the blade bodymounting structures (132, 134, 136, 138). An elongated tool engagablewith the blade securing device 144 (e.g., a hex screw driver or thelike) can be used to both move the blade securing device 144 between itsfirst position (e.g., untightened) and its second position (e.g.,tightened) and to set a desired orientation of the respective one of theblade bodies (102, 104, 106, 108) when the blade securing device 144 isin its first position. It is disclosed herein that that the presentinvention is not limited to any particular type or configuration ofmeans for securing the respective one of the blade bodies (102, 104,106, 108) in a fixed orientation (i.e., angulated and translatedorientation) with respect to the engaged one of the blade body mountingstructures (132, 134, 136, 138).

The blade body mounting structures 132, 134 of the first and secondblade translating units 112, 114 are jointly configured such that thefirst blade body 102 and the second blade body 104 are in opposed facingrelationship to each other. Similarly, the blade body mountingstructures 136, 138 of the first and second blade translating units 116,118 are jointly configured such that the third blade body 106 and thefourth blade body 108 are in opposed facing relationship to each other.As shown, in one embodiment of the present invention, the blade bodymounting structures 132, 134 of the first and second blade translatingunits 112, 114, respectively, extend substantially parallel with thesecond reference axis A2 and the blade body mounting structures 136, 138of the third and fourth blade translating unit 116 and the stationaryblade mounting structure 118, respectively, extend substantiallyparallel with the first reference axis A1.

Preferably, but not necessarily, all of the blade bodies (102, 104, 106,108) of the retractor apparatus 100 are identical (i.e., as shown inFIGS. 1-4). However, it is disclosed herein that blade bodies of aretractor apparatus in accordance with the present invention need not beidentical. For example, in an alternate embodiment, only blade bodiesthat are in opposed facing relationship to each other are the same aseach other. It is disclosed herein that each one of the blade bodies(102, 104, 106, 108) is an example of a retractor-mounted implement inaccordance with the present invention. Other examples of such aretractor-mounted implement include, but are not limited to, anancillary component mounting structure, a lighting device, a suctiondevice, a positioning device, a clamping device and the like. Suchretractor-mounted implement are configured for being engaged with theblade mounting structure in the same manner as the blade bodies (102,104, 106, 108).

Still referring to FIGS. 1-4, it can be seen that the retractorapparatus 100 can be used in a minimally invasive surgical procedure. Asshown in FIG. 1, the retractor apparatus 100 is positioned above aminimally invasive opening 150 within tissue 152 of a patient, with theblade bodies (102, 104, 106, 108) in an adjacent orientation BBO1 with arespective second end portion 146 (i.e., a tip portion) thereofextending through the minimally invasive opening 150. As shown in FIGS.2-4, the blade bodies ((102, 104, 106, 108) can be moved to a retractedorientation BBO2 through manipulation of the blade translating units(112, 114, 116). Furthermore, through manipulation of the securingdevice 142 of each one of the blade body mounting structures (132, 134,136, 138), angulation of the blade bodies (102, 104, 106, 108) can beindependently adjusted as necessary or desirable. Such angulation isuseful in that it allows portions of the tissue 150 within the minimallyinvasive opening 150 to be pushed back further than portions of thetissue 150 at an entrance to the minimally invasive opening 150.Accordingly, it can be seen that the retractor apparatus 100advantageously allows the tissue 152 to be retracted for sufficientlyexpanding the size of the minimally invasive opening 150 to allowstructures below the tissue 152 (e.g., vertebrae, bones, organs, etc) tobe accessed.

An alignment member 158 protrudes from an interior surface 159 of eachone of the blade bodies (102, 104, 106, 108). As will be discussed belowin greater detail, the alignment member 158 is engagable within a matingslot or channel of a pedicle screw extender 240 (shown in FIGS. 8-10)for limiting unrestricted rotation of an engaged one of the blade bodies(102, 104, 106, 108) about an extension portion 242 of the pedicle screwextender 240. The alignment member 158 and the mating slot or channel244 of the pedicle screw extender 240 are jointly configured forallowing the engaged one of the blade bodies (102, 104, 106, 108) to beslide along at least a portion of a length of the extension portion 242of the pedicle screw extender 240.

It is disclosed herein that the alignment member 158 of one or more ofthe blade bodies (102, 104, 106, 108) can be used for purposes inaddition to being engaged within the mating slot or channel of thepedicle screw extender 240. For example, the alignment member 158 of oneor more of the blade bodies (102, 104, 106, 108) can also be used as anattachment point for an external light source to help a surgeon withimprove vision into an invasive site. In view of the disclosures madeherein, a skilled person will appreciate other uses for the alignmentmember 158 of one or more of the blade bodies (102, 104, 106, 108).

As shown, the second end portion 146 of each one of the blade bodies(102, 104, 106, 108) is smoothly curved (i.e., radiused). However, forcertain procedures and/or uses, a skilled person will appreciate thatthe second end portion can be configured in a different manner. Foeexample, for some procedures and/or uses, the second end portion 146 canbe configured for being anchored within a bony structure. For suchprocedures and/or uses that require anchoring, the second end portion146 can be serrated, sharply pointed, or otherwise suitably configuredto allow for such anchoring.

Preferably, but not necessarily, all or a portion of the components ofthe retractor 101 are made from a fluoro-transparent orfluoro-translucent material. In at least one embodiment of the presentinvention, the retractor 101 is used in a surgical procedure where theretractor 101 will be installed on a patient during fluoroscopy of thepatient. A skilled person will be well aware of suitable surgical gradematerials and/or engineering grade materials that are fluoro-transparentor fluoro-translucent material. Depending on the specific application, askilled person will also appreciate that all or a portion of thecomponents of the retractor 101 can be made from materials such asstainless steel, carbon fiber, PEEK, titanium, or other such well knownmaterials from which surgical implements are and can be made.

Referring now to FIGS. 5 and 6, a blade body assembly 160 in accordancewith an embodiment of the present invention is shown. The blade bodyassembly 160 includes the first blade body 102 (i.e., the blade body102) discussed above in reference to FIGS. 1-4 and a blade body surround162. While the blade body shown in FIGS. 5 and 6 is the first blade body102 of FIGS. 1-4, it is disclosed herein that a blade body of the bladeassembly 160 can be any blade body suitably configured for use with theblade surround 162. Accordingly, any of the of the blade bodies (102,104, 106, 108) discussed above in reference to FIGS. 1-4 can be used incombination with the blade surround 162.

The blade body surround 162 has a first end portion 164, a second endportion 166, an interior surface 168 and an exterior surface 170. Theblade surround 162 has a slot 172 extending through the first endportion 164 and the second end portion 166. It is disclosed herein thatthe slot 172 can extend through the first and second end portions 168,170 or through the first end portion 164 and end adjacent to or at thesecond end portion 166. The blade body 102 and the blade body surround162 are jointly configured to form a generally cylindrical-shapedstructure when the blade body 102 is in a seated position SP within theslot 172. This cylindrical structure defines a central passage 171 (FIG.5) of the blade body assembly 160 that extends between the first andsecond end portions 164, 166 of the blade body surround 162. Preferably,but not necessarily, edge portions 173 of the slot 172 abut side edgesof the blade body 102 when the blade body 102 is in the seated positionSP within the slot 172.

The blade body surround 162 includes spaced apart blade attachmentbosses 174 at its first end portion 164. The spaced apart bladeattachment bosses 174 are one example of a blade body attachmentstructure 174. The slot 172 intersects each one of the spaced apartblade attachment bosses 174 in a manner providing recesses 176 in eachone of the spaced apart blade attachment bosses 174. The recess 176 ofeach one of the spaced apart blade attachment bosses 174 has a matingportion of the blade body 102 residing therein when the blade body 102is in the seated position SP within the slot 172. Preferably, therecesses 176, the edge portions 173 of the slot 172, and the blade body102 are jointly configured such that engagement of the blade body 102within the recesses 176 substantially constrains movement of the bladebody 102 relative to the blade body surround 162 to being along a lengthof the slot 172.

The retractor attachment structure 142 of the blade body 102 ispositioned between the spaced apart blade attachment bosses 174 when theblade body 102 is in the seated position SP within the slot 172. Eachone of the spaced apart blade attachment bosses 174 has a surroundengagement member 177 slideably mounted with a surround engagementmember receiving passage 178. The surround engagement member receivingpassage 178 is aligned with the mounting structure receiving passage 145of the retractor attachment structure 142 when the blade body 102 is inthe seated position SP within the slot 172. Each surround engagementmember 177 the blade body mounting structure is selectively movablebetween an engaged position SEM1 and a disengaged position SEM2. Eachsurround engagement member 177 is of a sufficient length for allowingsimultaneous engagement within the respective surround engagement memberreceiving passage 178 and the mounting structure receiving passage 145of the blade body 102 when in its engaged position SEM1 with the bladebody 102 is in the seated position SP within the slot 172. In thismanner, one or both of the surround engagement members 177 can limitdisplacement of the blade body 102 with respect to the blade bodysurround 162 when engaged within the mounting structure receivingpassage 145 of the blade body 102.

As shown in FIG. 7, a surround separating tool 200 is engagable with theblade body surround 162 for disengaging the surround engagement members177 and separating the blade body surround 162 from the blade body 102.The surround separating tool 200 includes a head portion 202 thatincludes spaced apart engagement member retractors 204. Each one of thespaced apart engagement member retractors 204 has a slotted tip portion206. The engagement member retractors 204 are spaced apart such that theblade body surround 162 can be positioned therebetween with one of theblade attachment bosses 174 inboard of each one of the engagement memberretractors 204. When engaging the head portion 202 with the blade bodysurround, the slotted tip portion 206 of each spaced apart engagementmember retractor 204 slides between the adjacent surround engagementmember 177 and adjacent blade attachment boss 174, thereby moving thesurround engagement member 177 from its engaged position SEM1 (see FIG.5) to its disengaged position SEM2. With each surround engagement member177 in its disengaged position SEM2, the blade body surround 162 can beslid out of engagement with the blade body 102 by pulling on thesurround separating tool 200 in a direction generally parallel with theslot edge portions 173.

FIGS. 8-10 shown various interactions between the blade body assembly160, the surround separation tool 200, the pedicle screw extender 240,and a blade assembly retainer 260. The pedicle screw extender 240includes a handle portion 241 and an extension portion 242. Theextension portion 242 includes a first end portion 243 and a second endportion 245. The handle portion 241 is attached to the second endportion 245 of the extension portion 242 in a manner allow torsionalforce resulting from twisting of the handle portion 241 to be exerted onthe extension portion 242.

The extension portion 242 of the pedicle screw extender 240 isconfigured for carrying the blade body assembly 160 during installationof a pedicle screw within a bony structure of a patient. The alignmentmember 158 (see FIGS. 1-4) of the blade body 102 is engaged within themating channel 244 of the extension portion 242 of the pedicle screwextender 240. The channel 244 extends from the first end portion 243 ofthe extension portion 242 toward its first end portion 243. In thismanner, the blade body 102 limits unrestricted rotation of the bladebody assembly 160 about the extension portion 242 of the pedicle screwextender 240 while allowing the blade body assembly 160 to be slidealong at least a portion of a length of the extension portion 242 of thepedicle screw extender 240. In one embodiment, the alignment member 158has a cross-sectional shape (e.g., t-shaped) that causes the alignmentmember 158 to be engaged within the mating channel 244. In this manner,the alignment member 158 and the mating channel 244 of the extensionportion 242 are jointly configured such that, once engaged with themating channel 244, the alignment member 158 is constrained within themating channel 244 in a manner allowing it to only slide therealong.

Referring to FIG. 11, the blade assembly retainer 260 is configured forbeing engaged with the extension portion 242 of the pedicle screwextender 240 in a manner that limits unrestricted movement of the bladebody assembly 160 along the length of the extension portion 242 of thepedicle screw extender 240. The blade assembly retainer 260 includes agenerally cylindrical retainer body 262 and an extension engagementmember 264. The extension engagement member 264 is pivotably mounted onthe retainer body with a first end portion 266 of the extensionengagement member 264 disposed within a slot 268 of the body retainer262 and a second end portion 270 engaged with an exterior surface of theretainer body 262. The second end portion 270 serves as a cantileverspring for urging the first end portion inward such that an arm 272attached to the second end portion 270 of the extension engagementmember 264 bears against the exterior surface of the retainer body 262.In this manner, the first end portion 266 is inwardly biased withrespect to a central passage 274 of the blade assembly retainer 260. Thefirst end portion 266 can be outwardly displaced through application offorce on the arm 272. The first end portion 266 of the extensionengagement member 264 includes a protrusion 276. The protrusion 276extends inwardly toward the central passage 274 of the blade assemblyretainer 260. As is discussed below in greater detail, the protrusion276 is engagable with a mating feature of the extension portion 242 ofthe pedicle screw extender 240 for securing the blade assembly retainer260 in a fixed position on the extension portion 242 of the pediclescrew extender 240. Protrusion 278 is engagable with the channel 244 ofthe extension portion 242 for limiting unrestricted rotation of theblade assembly retainer 260 about the extension portion 242 andmaintaining alignment of the protrusion 276 with the a mating feature ofthe extension portion 242 (e.g., spaced apart apertures 246 shown inFIG. 8).

Referring to FIGS. 8-10, in preparation for installation of a pediclescrew assembly using the pedicle screw extender 240, the blade assemblyretainer 260 is mounted on the extension portion 242 of the pediclescrew extender 240. The protrusion 276 of the blade assembly retainer260 is engaged with one of a plurality of spaced apart apertures 246within the extension portion 242 of the pedicle screw extender 240,thereby securing the blade assembly retainer 260 in a fixed positionalong the length of the extension portion 242 of the pedicle screwextender 240. The blade body assembly 160 is then slid onto theextension portion 242 of the pedicle screw extender 240 with thealignment member 158 of the blade body 102 engaged within the matingchannel 244 of the extension portion 242 of the pedicle screw extender240. The degree to which the blade body assembly 160 can be slid ontothe extension portion 242 of the pedicle screw extender 240 will thus bedictated by placement of the blade assembly retainer 260. As shown inFIGS. 9 and 10, engagement of the surround separation tool 200 with theblade body assembly 160 as discussed in detail in reference to FIG. 7provides for separation of the blade body surround 162 from the bladebody 102 while leaving the blade body still engaged with the extensionportion 242 of the pedicle screw extender 240. Such separation of theblade body surround 162 from the blade body 102 allows for the bladebody 102 to be engaged with a blade body mounting structure of aretractor apparatus (e.g., one of the one of the blade body mountingstructures (132, 134, 136, 138) of the retractor apparatus 100 discussedabove in reference to FIGS. 1-4). This assembly of the blade bodyassembly 160, the surround separation tool 200, the pedicle screwextender 240, and a blade assembly retainer 260 is referred to herein asa pedicle screw extender assembly.

Referring now to FIGS. 12 and 13, an embodiment of a structure forengagement of the pedicle screw extender 240 with a pedicle screwassembly 280 is discussed. In view of the disclosures made herein, askilled person will appreciate other embodiments for accomplishing suchengagement. Thus, the present invention is not unnecessarily limited toany particular structure for engagement of a pedicle screw extender inaccordance with the present invention with a pedicle screw assembly.

The first end portion 243 of the extension portion 242 of the pediclescrew extender 240 is configured for having the pedicle screw assembly280 engaged therewith. The first end portion 243 is configured fortransferring rotational torque applied to the elongated extensionportion 242 via the handle 242 (FIGS. 8-10) to a bone screw 282 (i.e., ascrew portion) of the pedicle screw assembly 280 while simultaneouslymaintaining a longitudinal axis A3 of a fixation rod receiving body 284of the pedicle screw assembly 280 in coincidental alignment with alongitudinal axis A4 of the bone screw 282.

As shown in FIG. 12, a body engagement member 247 extends from aninterior surface 249 of the extension portion 242 at its first endportion 243. The body engagement member 247 is engaged with a matingfeature 286 (e.g., threads) on an exterior surface 288 of the fixationrod receiving body 284 of the pedicle screw assembly 280. Through suchengagement of the body engagement member 247 with the mating feature 286of the fixation rod receiving body 284 of the pedicle screw assembly280, a longitudinal axis A5 of the extension portion 242 of the pediclescrew extender 240 is held in substantial alignment with thelongitudinal axis A3 of the fixation rod receiving body 284 of thepedicle screw assembly 280.

A torque application member 251 of the pedicle screw extender 240 isslideable mounted within a central passage (i.e., defined by theinterior surface 249) of the extension portion 242. The torqueapplication member 251 is slideable between a disengaged position TAM1(FIG. 12) and an engaged position TAM2 (FIG. 13). For example, slidingof the torque application member 251 can implemented via a movementcontrol mechanism mounted on/within the handle 241. The torqueapplication member 251 is engaged with the extension portion 242 and/orthe handle 241 in a manner allowing torque applied to the handle 241 tobe at least partially, if not fully, exerted on the torque applicationmember 251. Examples of means for allowing such torque transmissionbetween the handle and the torque application member 251 include, butare not limited to, a splined interface, non-round interface or thelike.

When the torque application member 251 is in its disengaged positionTAM1, a tip portion 253 of the torque application member 251 isdisengaged from within a torque application portion 290 of the bonescrew 282 and a rod saddle engaging portion 255 of the torqueapplication member 251 is disengaged from within a rod receiving saddle292 of the fixation rod receiving body 284, as is shown in FIG. 12. Thebody engagement member 247 can be readily engaged with the matingfeature 286 of the fixation rod receiving body 284 of the pedicle screwassembly 280 when the torque application member 251 is in its disengagedposition TAM1. A recessed structure configured for receiving a flat tipdriver, a star/cross driver, a hex driver, or the like is an example ofthe torque application portion 290 of the bone screw 282. When thetorque application member 251 is in its engaged position TAM2, the tipportion 253 of the torque application member 251 is engaged within thetorque application portion 290 of the bone screw 282 and the rod saddleengaging portion 255 of the torque application member 251 is engagedwithin the rod receiving saddle 292 of the fixation rod receiving body284. The rod saddle engaging portion 2 and the rod receiving saddle 292are jointly configured to preclude relative rotational movementtherebetween when the rod saddle engaging portion 255 is engaged withinthe rod receiving saddle 292, thereby securing the pedicle screwassembly 280 to the pedicle screw extender 240 while the torqueapplication member 251 is in its engaged position TAM2. Throughengagement of the torque application member 251 with the torqueapplication portion 290 of the bone screw 282, the longitudinal axis A5of the extension portion 242 of the pedicle screw extender 240 is heldin substantial alignment with the longitudinal axis A4 of the bone screw282. Furthermore, the present invention is advantageously notunnecessarily limited to use with a particular type, brand orconfiguration of pedicle screw assembly as the first end portion 243 ofthe extension portion 242 of the pedicle screw extender 240 can beconfigured for use with a particular pedicle screw assembly.

FIG. 14 shows a tissue dilator 300 configured specifically for use withthe blade body assembly 160. As discussed above, the blade body 102 andthe blade body surround 162 are jointly configured to form a generallycylindrical-shaped structure when the blade body 102 is in a seatedposition within the slot 172 (FIG. 6) of the blade body surround 162.This cylindrical structure defines a central passage 171 (FIG. 5) of theblade body assembly 160 that extends between the first and second endportions 164, 166 of the blade body surround 162. Also discussed above,the blade body 102 has an alignment member 158 that protrudes from itsinterior surface 159. As such, the tissue dilator 300 has a D-shapedcross sectional profile to accommodate the alignment member 158 (i.e., aflat sidewall 302 of the tissue dilator 300 provides clearance for thealignment member 158).

The tissue dilator 300 is one of a series of dilators used with theblade body assembly 160. Preferably, all of the dilators have the samecross-sectional shape as the dilator 300. The dilator 300 is thelargest, with the next smaller size dilator being sized to be slideablyengaged within the dilator 300 in a close tolerance manner. Similarly,each dilator of the series is similarly sized to fit within the nextlarger size dilator.

Discussed now is a method of using the surgical retractor systemcomponents discussed above in a lumbar spine fusion surgical procedure.A lumbar spine fusion surgical procedure is one example of the manysurgical procedure where surgical retractor system components inaccordance with the present invention will find applicability. In viewof the inventive disclosures made herein, a skilled person willappreciate other known and yet to be discovered surgical procedures inwhich surgical retractor system components in accordance with thepresent invention will find applicability.

An overall method of using such surgical retractor system components ina lumbar spine fusion surgical procedure includes the followingoperations (i.e., steps). A K-wire is installed through tissue of apatient into a bony structure into which a pedicle screw assembly is tobe placed. After the K-wire is installed, a series of tissue dilators(i.e., those discussed above in reference to the tissue dilator 300) areinstalled over the K-wire, thereby dilating soft tissue of the patient.Next, a first pedicle screw assembly is engaged with a first pediclescrew extender assembly configured in accordance with an embodiment ofthe present invention (i.e., the pedicle screw extender 240 having theblade assembly 160 and the blade assembly retainer 260 mounted thereonas discussed above in reference to FIGS. 8-13). The pedicle screwassembly can be any suitable cannulated pedicle screw assembly such asthose that are currently commercially available from numerousmanufacturers. The pedicle screw extender 240 will be configured for usewith a corresponding pedicle screw assembly.

The first pedicle screw assembly is then driven into the required bonystructure of a patient (e.g., a vertebrae) through the largest one ofthe tissue dilators (i.e., smaller tissue dilators removed asnecessary). It is disclosed herein that the pedicle screw assembly andthe pedicle screw extender 240 are preferably cannulated for allowingplacement over the k-wire. The pedicle screw extender assembly remainsattached to the respective pedicle screw assembly at this point in themethod. The operations performed thus far for installing the firstpedicle screw assembly are then repeated for at least a second pediclescrew assembly (i.e., a pair of installed pedicle screw assemblies inspaced apart relationship, with each pedicle screw assembly beinginstalled with a respective pedicle screw extender assembly). Forexample, a first pedicle screw assembly can be installed in a firstvertebrae and the second pedicle screw assembly can be installed in asecond vertebrae.

Next, the surround separation tool 200 discussed above in reference toFIGS. 8-10 is used for separating the blade body surround 162 from eachblade body assembly 160. The blade body surround 162 and the blade bodysurround separation tool 200 are removed from within the dilator 300. Asdiscussed above, the blade body of each blade body assembly (i.e., theblade body 102, 104) remain engaged with the respective pedicle screwextender 240 even after the blade body surround 162 is removed from eachone of the blade body assemblies 160.

At this point in the method, the largest dilator (i.e., dilator 300) isstill in place within tissue at a surgical site of the patient, twopedicle screw assemblies are installed within respective bony structureof the patient, and each one of the pedicle screw assemblies has arespective pedicle screw extender 240 attached thereto. Each pediclescrew extender 240 has a respective blade body (102, 104) attachedthereto and is extending through a respective dilator.

The blade body on each pedicle screw extender 240 is now slid downwardinto the dilator such that an upper end portion of the blade body isabove the tissue of the patient and a lower end portion of each bladebody is below a surface of the tissue (i.e., is within a minimallyinvasive surgical site of the patient). A retractor attachment structure142 of each one of the blade bodies 102, 104 is attached to a respectiveblade body mounting structure (i.e., blade body mounting structure 132and blade body mounting structure 134) of the retractor 101. Preferably,but not necessarily, the retractor 101 is fixedly attached to anarticulating arm of an operating table. For example, the stationaryblade mounting structure 118 of the retractor 101 can have an integralmounting structure configured for being attached to a fixed body suchas, for example, the operating table or a floor-mounted structure.

With the blade bodies 102, 104 attached to the blade body mountingstructures 132, 134 of the retractor 101, angulation of each one of theblade bodies 102, 104 can set through use of the blade securing device144 thereof and a suitable tool (e.g., a hex driver). The pedicle screwextender 240, including the respective blade assembly retainer 260, isthen detached from each one of the pedicle screw assemblies and isremoved from within the dilator 300. The dilator 300 and K-wire are nowremoved and the tissue is retracted accordingly through use of the firstand/or second blade translating units 112, 114 of the retractor 101.During such retraction, angulation of one or both of the blade bodies102, 104 can be adjusted. If required and/or desired, a retractorattachment structure 142 of two secondary blade bodies (e.g., bladebodies 106, 108) can be attached to respective secondary the blade bodymounting structures (e.g., the third blade body mounting structure 136and the fourth blade body mounting structure 138) of the retractor 101and retracted accordingly through use of a respective blade translatingunit (e.g., the third blade translating unit 116) of the retractor 101.

As can be gathered from the foregoing discussions and disclosures, aretractor apparatus and associated surgical retractor system componentsconfigured in accordance with the present invention advantageously allowretractor placement over a pedicle screw assembly/pedicle screw extenderconstruct allows visualization of the spine anatomy directly.Furthermore, a retractor configured in accordance with the presentinvention can be built off of the pedicle screw assemblies and attachedpedicle screw extenders ensures ideal placement of the retractor foradditional procedures that are often required (e.g., decompression,interbody device placement, etc).

In the preceding detailed description, reference has been made to theaccompanying drawings that form a part hereof, and in which are shown byway of illustration specific embodiments in which the present inventionmay be practiced. These embodiments, and certain variants thereof, havebeen described in sufficient detail to enable those skilled in the artto practice embodiments of the present invention. It is to be understoodthat other suitable embodiments may be utilized and that logical,mechanical, chemical and electrical changes may be made withoutdeparting from the spirit or scope of such inventive disclosures. Toavoid unnecessary detail, the description omits certain informationknown to those skilled in the art. The preceding detailed descriptionis, therefore, not intended to be limited to the specific forms setforth herein, but on the contrary, it is intended to cover suchalternatives, modifications, and equivalents, as can be reasonablyincluded within the spirit and scope of the appended claims.

1. A method for performing surgery, comprising: providing a pediclescrew apparatus including a pedicle screw assembly having a first endportion of a pedicle screw extender attached thereto in a mannerproviding for simultaneous transfer of rotational torque applied theretoto a screw portion of the pedicle screw assembly and for maintaining alongitudinal axis of a fixation rod receiving body of the pedicle screwassembly in substantially coincidental alignment with a longitudinalaxis of the screw portion; anchoring the pedicle screw assembly to abony structure of a patient, wherein said anchoring includes using thepedicle screw extender to apply rotational torque to the screw portionof the pedicle screw assembly; engaging a blade body with the pediclescrew extender in a manner allowing the blade body to be moved along thepedicle screw extender from a second end portion thereof toward thefirst end portion thereof after the pedicle screw assembly is anchoredwithin the bony structure and while the pedicle screw extender isengaged with the pedicle screw assembly; moving the blade body fromadjacent the second end portion of the pedicle screw extender toward thefirst end portion thereof for positioning a first end portion of theblade body within tissue of the patient; and engaging a retractorattachment structure at the second end portion of the blade body with ablade body mounting structure of a retractor after performing saidmoving.
 2. The method of claim 1 wherein engaging the retractorattachment structure with the blade body mounting structure includespivotably adjusting the blade body with respect to the blade bodymounting structure.
 3. The method of claim 2, further comprising:inhibiting the blade body from being pivoted with respect to the bladebody mounting structure after pivotably adjusting the blade body withrespect to the blade body mounting structure.
 4. The method of claim 1wherein engaging the blade body with the pedicle screw extender includesengaging an alignment member of the blade body within a mating alignmentgroove of the pedicle screw extender.
 5. The method of claim 1 wherein:the blade body has a blade body surround attached thereto when saidengaging of the blade body is performed; the blade body surround has afirst end portion, a second end portion, an interior surface and anexterior surface; the blade surround includes a slot extending throughthe first end portion thereof; the blade body surround and the bladebody jointly form a generally cylindrical-shaped structure when theblade body is in a seated position within the slot of the blade bodysurround; the cylindrical structure defines a central passage thereofextending between said first and second end portions of blade bodysurround; and the pedicle screw extender extends through the centralpassage of said cylindrical-shaped structure.
 6. The method of claim 5,further comprising: detaching the blade body surround from the bladebody prior to engaging the retractor attachment structure with the bladebody mounting structure.
 7. The method of claim 6, further comprising:disengaging the pedicle screw extender from the pedicle screw assembly;and withdrawing the pedicle screw extender from within said tissue afterdisengaging the pedicle screw assembly from the pedicle screw extender.8. The method of claim 7: wherein engaging the retractor attachmentstructure with the blade body mounting structure includes pivotablyadjusting the blade body with respect to the blade body mountingstructure; and further comprising: inhibiting the blade body from beingpivoted with respect to the blade body mounting structure afterpivotably adjusting the blade body with respect to the blade bodymounting structure.
 9. A method for performing minimally invasivesurgery, comprising: engaging a first end portion of a pedicle screwextender with a fixation rod receiving body of a pedicle screw assembly,wherein the pedicle screw extender is engaged in a manner allowingsimultaneous transfer of rotational torque applied thereto to a screwportion of the pedicle screw assembly and maintaining a longitudinalaxis of the fixation rod receiving body in substantially coincidentalalignment with a longitudinal axis of the screw portion; anchoring thepedicle screw assembly to a bony structure of a patient through aminimally invasive access opening in tissue at a surgery site, whereinsaid anchoring includes using the pedicle screw extender to applyrotational torque to the screw portion of the pedicle screw assembly;engaging a blade body with the pedicle screw extender at an exposedposition above said tissue after the pedicle screw assembly is anchoredwithin the bony structure and while the pedicle screw extender isengaged with the pedicle screw assembly; sliding the blade body from asecond end portion of the pedicle screw extender toward the first endportion of the pedicle screw extender for positioning a first endportion of the blade body within the minimally invasive access openingin said tissue; disengaging the pedicle screw extender from the pediclescrew assembly; withdrawing the pedicle screw extender from within theminimally invasive access opening in said tissue after disengaging thepedicle screw assembly therefrom, wherein said withdrawing includedisengaging the pedicle screw extender from the blade body while thefirst end portion of the blade body remains within the minimallyinvasive access opening; and engaging a retractor attachment structureat the second end portion of the blade body with a blade body mountingstructure of a retractor after performing said withdrawing.
 10. Themethod of claim 9 wherein engaging the blade body with the pedicle screwextender includes engaging an alignment member of the blade body withina mating alignment groove of the pedicle screw extender.
 11. The methodof claim 10 wherein engaging the retractor attachment structure with theblade body mounting structure includes pivotably adjusting the bladebody with respect to the blade body mounting structure.
 12. The methodof claim 11, further comprising: inhibiting the blade body from beingpivoted with respect to the blade body mounting structure afterpivotably adjusting the blade body with respect to the blade bodymounting structure.
 13. The method of claim 12 wherein: the blade bodyhas a blade body surround attached thereto when said engaging of theblade body is performed; the blade body surround has a first endportion, a second end portion, an interior surface and an exteriorsurface; the blade surround includes a slot extending through the firstend portion thereof; the blade body surround and the blade body jointlyform a generally cylindrical-shaped structure when the blade body is ina seated position within the slot of the blade body surround; thecylindrical structure defines a central passage thereof extendingbetween said first and second end portions of blade body surround; andthe pedicle screw extender extends through the central passage of saidcylindrical-shaped structure.
 14. The method of claim 13, furthercomprising: detaching the blade body surround from the blade body priorto engaging the retractor attachment structure with the blade bodymounting structure.
 15. The method of claim 14, further comprising:disengaging the pedicle screw extender from the pedicle screw assembly;and withdrawing the pedicle screw extender from within the minimallyinvasive access opening after disengaging the pedicle screw assemblyfrom the pedicle screw extender.
 16. A method for performing surgery,comprising: anchoring a first pedicle screw apparatus to a first bonystructure of a patient and a second pedicle screw apparatus to a secondbony structure of the patient, wherein each one of said pedicle screwassemblies includes a pedicle screw assembly having a first end portionof a pedicle screw extender attached thereto in a manner providing forsimultaneous transfer of rotational torque applied thereto to a screwportion of the pedicle screw assembly and for maintaining a longitudinalaxis of a fixation rod receiving body of the pedicle screw assembly insubstantially coincidental alignment with a longitudinal axis of thescrew portion; engaging a first blade body with the pedicle screwextender of the first pedicle screw assembly and a second blade bodywith the pedicle screw extender of the second pedicle screw assemblyafter performing said anchoring and while each one of the pedicle screwextends is engaged with the respective one of said pedicle screwassemblies; displacing each one of said blade bodies from a second endportion of the respective pedicle screw extender toward the first endportion thereof for positioning a first end portion of each one of saidblade bodies within tissue of the patient adjacent the respective one ofsaid bony structures; disengaging each one of said pedicle screwextenders from the respective one of said pedicle screw assemblies; andengaging a retractor with both of said blade bodies after performingsaid displacing.
 17. The method of claim 16: wherein engaging theretractor with at least one of said blade bodies includes pivotablyadjusting said at least one of said blade body with respect to theretractor; and further comprising inhibiting said at least one of saidblade bodies from being pivoted with respect to the retractor afterpivotably adjusting said at least one of said blade bodies with respectto the retractor.
 18. The method of claim 16 wherein engaging each oneof said blade bodies with the respective one of said pedicle screwextenders includes engaging an alignment member of each one of saidblade bodies with a mating alignment groove of the respective one ofsaid pedicle screw extenders.
 19. The method of claim 16 wherein: atleast one of said blade bodies has a blade body surround attachedthereto when said engaging of said at least one of said blade body isperformed; the blade body surround has a first end portion, a second endportion, an interior surface and an exterior surface; the blade surroundincludes a slot extending through the first end portion thereof; theblade body surround and said at least one of said blade bodies jointlyform a generally cylindrical-shaped structure when said at least one ofsaid blade bodies is in a seated position within the slot of the bladebody surround; the cylindrical structure defines a central passagethereof extending between said first and second end portions of bladebody surround; and the pedicle screw extender engaged with said at leastone of said blade bodies extends through the central passage of saidcylindrical-shaped structure.
 20. The method of claim 19, furthercomprising: detaching the blade body surround from said at least one ofsaid blade bodies prior to engaging the retractor with said at least oneof said blade bodies.